Chronic Cough/Bronchiectasis – Pediatrics: Difference between revisions

From Guide to YKHC Medical Practices

 
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===Resources/References===
===Resources/References===
* [[media:Bronchiectasis.pdf|Bronchiectasis: Prevention and Management 2016]] (PowerPoint Presentation by Rosalyn Singleton, MD)
* [[media:Bronchiectasis.pdf|Bronchiectasis: Prevention and Management 2016]] (PowerPoint Presentation by Rosalyn Singleton, MD)
* Munro, et al.  [https://www.researchgate.net/profile/Catherine_Byrnes/publication/228632714_Burden_of_Bronchiectasis_in_Indigenous_Peoples-How_Can_it_be_Improved/links/02bfe51326836e5853000000/Burden-of-Bronchiectasis-in-Indigenous-Peoples-How-Can-it-be-Improved.pdf Burden of Bronchiectasis in Indigenous Peoples- How Can it be Improved?].  ''Current Pediatric Reviews.'' 2009, 5, 00-00.
* Singleton RJ et al. [https://onlinelibrary.wiley.com/doi/abs/10.1002/ppul.22763 Indigenous children from three countries with non-cystic fibrosis chronic suppurative lung disease/bronchiectasis]. ''Pediatr Pulmonol'' 2014.
* Singleton RJ et al. [https://onlinelibrary.wiley.com/doi/abs/10.1002/ppul.22763 Indigenous children from three countries with non-cystic fibrosis chronic suppurative lung disease/bronchiectasis]. ''Pediatr Pulmonol'' 2014.
* Redding et al. [https://www.sciencedirect.com/science/article/pii/S0012369215510817?via%3Dihub Respiratory Exacerbations in Indigenous Children From Two Countries With Non-Cystic Fibrosis Chronic Suppurative Lung Disease/Bronchiectasis]. CHEST 2014:146;762-4
* Redding et al. [https://www.sciencedirect.com/science/article/pii/S0012369215510817?via%3Dihub Respiratory Exacerbations in Indigenous Children From Two Countries With Non-Cystic Fibrosis Chronic Suppurative Lung Disease/Bronchiectasis]. CHEST 2014:146;762-4

Latest revision as of 07:05, 18 February 2021

Pathophysiology: Recurrent pneumonia and lower respiratory tract infections cause airway damage that leads to "ectasia" and loss of elasticity of bronchi. Loss of muco-ciliary function leads to difficulty clearing secretions.
Risk Factors:

  • Prematurity
  • Immunocompromise
  • Early recurrent respiratory infections
  • Previous injury
  • Environmental effects (lack of piped water, household crowding, woodstove use)

Demographics: Alaska YK Delta: 1 in 63 children, Central Australia: 1 in 68, U.S.: 1 in 250,000.
Signs/Symptoms: Chronic wet cough, respiratory exacerbations with fever, crackles, wheezing
Diagnosis: Progression of disease from protracted bronchitis to chronic suppurative lung disease (3 episodes at least 3 months each) to CT scan confirmed Bronchiectasis
Management:

  • Reduce infection-inflammation: treat early and exacerbations 'aggressively' with antibiotics, airway hygiene clearance, vaccinations
  • Improve other factors contributing: attention to nutrition, detect complications, pollutants
  • Systemic care: regular review, multi-disciplinary care, education, enhance self care and management
  • Collaboration with Seattle Children's Hospital Pulmonologists who generally see patients in a Bethel Field Clinic 3-4 times a year
  • Special attention in adolescents to transferring to adult care.

Critical Times for Affected Patients: exacerbations – antibiotic treatment important, prophylaxis if frequent exacerbations, transition to adulthood critical – poorly managed bronchiectasis can lead to early COPD and death

Resources/References


YKHC Clinical Guidelines
Common/Unique Medical Diagnoses